I think this is a well written article on a topical subject, especially in primary care, more so in the recent past.

I feel the approach which has been taken across the NHS in primary care to reduce emergency care is a somewhat naïve one. It’s quite obvious with the majority of the patients that they are not keen on getting admitted, given an option they would prefer to be managed in the community. With the current commission groups, unsurprisingly realising, the cost of emergency admissions are trying to highlight the issue among surgeries. In some regions there is name and shame of practices with high emergency admissions (I am not sure if there is carrot shown to some practices in some regions).

But the root cause has to be dealt if we want to see long lasting results of reduced emergency admissions. Services which are lacking in the community need to be looked at. There should be planned measures regarding how to put these services back into the community, which patients can then access when in need. Thus they can be dealt with in the community and don’t end up ringing 999 and getting admitted to hospital (unwillingly most of the time).

We get monthly PARR data for our practice patients; we have monthly MDTs (multidisciplinary meetings) to reduce emergency admissions. We do try to discuss how to rectify potential problems for patients to reduce future admissions. But there is a great shortage of various services in the community, which needs to be addressed to see real benefits.

Competing interests: None declared